Surgical instrument



llnited @ttes Patent 1 wanna Frank M. Cornell Franklin Ave. and Colonial Road, FranklinlLakes, New Jersey 07417 [21] Application No.: 662,649

[22] Filed: Aug. 23,1967

[45] Patented: Aug. 4, 1970 [72] Inventor:

[54] SURGICAL llNSTRlUMlENT 12 Claims, 3 Drawing Figs.

[52] U.S.Cl. 128/305,

30/359 51 Int. c1. A611) 17 32 [50] Field ofSearch 128/2, 28,

Surgery: lsmet Hallac, vol. 51, No. 4; April 1962; pp.5l5--5l7.

Primary Examiner- Anton O. Oechsle Assistant Examiner- Richard J. Apley Attorney-Spencer and Kaye ABSTRACT: A surgical instrument for removing and transplanting patches of skin or other tissue having a predetermined geometrical configuration and a predetermined thickness. A tubular body member is provided having an adjustable plunger within the tube and a hollow, annular knife member attached to one end of the tube. The plunger is adjustable within the hollow annular knife member and acts as an abutment to limit the depth ofthe annular incision which is made in a piece of skin or other tissue when the annular knife member is pressed thereagainst. A flat knife member is mounted on the tubular housing and is movable approximately perpendicularly to the cutting edge of the annular knife to cut free the patch of tissue which is contained within the hollow interior of the annular knife member after it has been pressed into the tissue. The flat knife member is flexible and is movable within a curved guide attached to the tubular body member. The end of the curved guide is positioned in align' ment with the cutting edge of the annular knife member so that the flat knife cooperates with the cutting surface of the annular knife to remove a patch of tissue having a precisely determined geometrical configuration and thickness,

Patented Aug. 4, 1970 3,522,809

FIG.3.

INVENTOR Frank M. Cornell ATTORNEYS U .S. PATENT 3,522,809 SURGICAL INSTRUMENT BACKGROUND OF THE INVENTION This invention relates to a surgical instrument for removing and transplanting a patch of cutaneous or other tissue having a predetermined geometrical configuration and a predetermined thickness. Such operations are necessary both in preparing laboratory samples of animal or human tissue for microscopic study or in transplanting patches of tissue from one location to another. In the past, the removal of such patches of tissue has been accomplished by manually making an incision with a simple scalpel along a path approximating the desired geometrical configuration and subsequently cutting the tissue parallel with its exposed surface by means of a second instrument. This manual method of removing such tissue has several serious drawbacks however. The manual removal of a patch of tissue by the prior art methods tended to expel the tissue fluids and disrupt the cells, which not only presented serious difficulties in microscopic study, but also, in transplants, presented the more serious difficulty that the patch of donor tissue never exactly matched the receptor site. Accordingly, it is the object of this invention to provide a surgical instrument for accurately removing such patches of cutaneous or other tissue and for transplanting such patches of tissue without the disadvantages of ragged or inaccurate edges, thereby facilitating the control of bleeding, facilitating healing, and minimizing the chance of infection or scarring at either the donor or receptor site.

SUMMARY OF THE INVENTION In accordance with this invention, a surgical instrument has been devised for removing and transplanting an accurately defined patch of cutaneous or other tissue having a predetermined geometrical configuration and a predetermined thickness. The invention comprises a tubular body member having a hollow, annular knife attached to one end thereof and a plunger movable therewithin. The cutting edge of the hollow; annular knife accurately defines the geometrical configuration of the desired patch oftissue, and the hollow, annular knife is preferably removably attached to one end of the tubular body member, and a plurality of hollow, annular knife members having different geometric configurations are provided. The plunger is movable within the interior of the hollow, annular knife member and acts as an abutment to define the depth of incision produced when the knife member is pressed against the tissue to be removed. Set screw means are provided to securely hold the plunger in any desired position corresponding to any desired depth of incision. A flat knife is mounted movable perpendicular to the cutting edge of the hollow, annular knife to cut off the patch of tissue contained within the hollow interior of the annular knife after it has been pressed against the tissue to be removed. The flat knife is flexible and is mounted withina curved guide member whose lower surface is aligned with the cutting edge of the annular knife. The curved guide member extends through approximately 90 of arc and the flat knife member movable therewithin is attached at its upper end to a piston member which is approximately parallel to the axis of the tubular body member. The flat knife member is moved within the guide member by a rocker arm assembly which is pivotably attached to the side of the tubular body member and is reciprocally attached to the piston member. A thumb lever is attached to one end ofthe rocker arm assembly so that the flat knife can be ac-' tuated by an easy thumb motion transverse to the tubular body member. 1

BRIEF DESCRIPTION OF THE DRAWINGS FIGURE l is a side view of one illustrative surgical instrument ofthis invention.

FIGURE 2 is across-sectional view of the embodiment shown in FIGURE 1.

FIGURE 3 is a bottom view of the embodiment shown in FIGURE 1.

DESCRIPTION OF THE PREFERRED EMBODIMENT Referring to FIGURES 1 through 3, the preferred embodiment of the invention comprises a tubular body member 10 which is fitted at one end with a hollow bushing member 12 and at its other end with a hollow, annular knife member 14. Both the bushing member 12 and the knife member 14 are removably attached to the body member 10 by means of screw threads. The bushing member 12 acts as a guide for a movable plunger 16 which is slidable within the body member 10 and is supported at one end by bushing member 12 a d at the other end by an internal shoulder 18 of body men set It. Plunger 16 has a disc-shaped thumb piece 20 attached to the upper end thereof, and below thumb piece 20, a movable collar member 22 is slidably attached to the plunger 16 and carries a set screw 24. The movable collar 22 and set screw 24 can be adjusted to any desired position to set the lower end surface of plunger 16 at any desired spacing from the cutting edge 26 of the annular knife 14. Therefore, by an appropriate setting of the collar 22 and set screws 24, any desired depth of incision can be preset into the disclosed embodiment so that, when the plunger 16 is depressed to the level determined by the setting of collar 22, and the cutting edge 26 of annular knife 14 is pressed against the tissue to be cut, an annular incision having an accurately predetermined geometrical configuration and an accurately predetermined depth will be made.

After such an incision has been made, the tissue contained within the hollow interior of annular knife 14 is cut off on a plane substantially parallel with the surface of the tissue at the bottom of the incision made by the cutting edge 26 thereof by means of a flat, flexible knife 28 which is movably mounted within a curved guide member 30. Guide member 30 is attached by means of a bracket 32 to the housing 10 and contains a curved guide channel 34 thercwithin which extends through approximately of arc and which is dimensioned to receive the flat, flexible knife 28. The lowermost end of channel 34 is aligned with the cutting edge 26 of annular knife 14 and is approximately tangent thereto so that when the flexible knife 28 is moved out of the end of the channel 34, it will make contact with the cutting surface of annular knife 26. As best shown in FIGURE 3, the cutting edge of flat, flexible knife 28 is preferably rounded.

A cylinder member 36 projects from the upper end of curved guide member 30 and receives a piston member 38 which is attached to the upper end of the flexible knife 28 and which moves the knife 28 upwardly and downwardly at the upper end of channel 34. Due to the 90 curve of channel 34, of course, it will be obvious that the up and down motion of piston 38 is translated into a sideways motion of flat knife 28 at the other end of the guide channel 34. Piston 38 is spring biased in its upward position by a compression spring 39. the upward position of piston 38 corresponding to the retracted position ofthe flat knife 28.

Plunger 38 is moved upwardly and downwardly by means of a rocker arm assembly containing rocker arms 40 and 42 which are pivotally attached to opposite sides of housing member 10 by pivot pins 44 and 46. A thumb lever 48 is attached between one end of the rocker arms 40 and 42, whose other ends are slotted to receive pins 50 and 52, which are attached to piston 38, for imparting a reciprocating movement to piston 38 when the rocker arms 40 and 42 are moved by thumb pressure on thumb lever 48 or returned upwardly by means of the spring 39.

The procedure for removing a predetermined patch of skin be made by an actual measurement between the bottom surface of the plunger 16 and the cutting edge 26 of annular knife member 14, or it may by made by means of calibration markings on the plunger 16. After the collar 22 has been set to the desired depth, the plunger 16 is depressed as far as it will go by applying thumb pressure to thumb disc 20, and the cutting edge 26 of annular knife 14 is simultaneously pressed against the surface of the tissue from which the desired patch of tissue is to be cut. The cutting edge 26 of annular knife 14 then makes an annular incision to a depth determined by the setting of the plunger 16. After the annular incision has been made, the thumb lever 48 is then depressed to move the flat knife member 28 across the bottom of cutting edge 26 to sever the tissue patch which is then contained in the interior of annular knife 14. The patch of tissue which has been thus cleanly cut from the tissue surface in question can then be removed by simply lifting the housing member 10. When the thumb pressure on thumb lever 48 is removed, spring 39 will return the flat knife member 28 to its retracted position within guide member 30. The tissue patch can then be expelled for microscopic study or for transplantation by loosening set screw 24 and by depressing plunger 16 to eject the patch of tissue from the inside of annular knife member 14.

In the case of transplantation, apair of matching instruments is used fitted with identical annular knives. A receptor site is prepared with one of the instruments by the method described above. A donor tissue patch having the same size, configuration, and thickness as the receptor site is accurately prepared by cutting a patch of tissue from the donor site with the other instrument. The patch of donor tissue can then be quickly and accurately placed in the receptor site by releasing the collar set screw and ejecting the patch of tissue precisely into the receptor site. The tissue from the receptor site may likewise be deposited from the other instrument into the donor site if desired. lt will be apparent that repeated transfers of minute bits oftissue, which would otherwise require laborious effort on the part of the surgeon, can be easily effected by the surgical instrument of this invention.

The invention also provides other important advantages, particularly where pleasing cosmetic result is desirable.

With the instrument of this invention, a minimum of anaesthesia is required at the site of the operation. Thus, normal exchange of tissue fluids is not hampered. The fluids and cells normally present in the sample before the operation are not expressed during the cutting process. Thus the vitality of the transferred tissue is undiminished. The retention of such fluids and cells is advantageous in cases where a microscopic study of non-transplantable tissue is desired.

Moreover, with the instrument of this invention, the transfer of the donor tissue into the receptor site is accomplished without ragged or inaccurate edges, and this facilitates healing, controls bleeding and edema, requires a minimum of dressing, minimizes the chance of infections, and produces little or no scarring, either at the donor or receptor sites. With tissue reaction thus reduced to a minimum, it may be supposed that exogenous transplantation will become more feasible.

It will be understood that the above description of the present invention is susceptible to various modifications, changes and adaptations, and the same are intended to be comprehended within the meaning and range of equivalents of the appended claims.

I claim:

l. A surgical instrument for removing a patch of biological tissue, having a predetermined geometrical configuration and a predetermined thickness, said surgical instrument comprising, in combination:

(a) first knife means comprising a hollow, annular knife member with an annular cutting edge having a predetermined geometrical configuration for making an incision in a surface of such biological tissue along a closed path, said incision being made substantially simultaneously in all points of said surface along said closed path to a depth at least approximately equal to said predetermined thickness;

(b) means within the interior ofsaid hollow, annular knife member for limiting the depth of an incision made thereby comprising a plunger movable within the interior of said hollow member and means for setting said plunger at a predetermined distance from the annular cutting edge of said annular knife member;

(c) second knife means for cutting the tissue within said closed path along a plane approximately parallel to the surface of said tissue at a depth below the surface thereof approximately equal to said predetermined thickness to remove a patch of such tissue having said predetermined geometrical configuration and said predetermined thickness comprising a flat knife member mounted adjacent to said first knife means and movable transverse to said annular cutting edge thereof wherein said flat knife member is flexible, and wherein said mounting means comprises a curved guide member attached to said one end of tubular body member, one end of said curved guide member being positioned in alignment with the cutting edge of said annular knife member, and means at the other end of said curved guide member for extending said flat knife member from said curved guide member and for withdrawing said flat knife member into said curved guide member, and

(d) a tubular body member, and means on one end of said tubular body member for removably attaching said hollow, annular knife member thereto, said plunger being movably mounted within the interior of said tubular body member and said flat knife member being mounted on said one end of said tubular body member.

2. The combination defined in Claim 1 wherein said means for moving said flat knife member comprises a piston-cylinder assembly attached to and projecting from the outer end ofthe curved guide member, the piston of said piston-cylinder assembly being attached to said flat knife member, and means attached to said piston for moving the piston upwardly and downwardly within said cylinder.

3. The combination defined in Claim 2 wherein said pistoncylinder assembly is approximately parallel with the axis of said tubular body member, said curved guide member having a curvature of approximately and the curvature at said one end of said curved guide member being approximately tangent to the annular cutting edge of said first knife means.

4. The combination defined in Claim 3 wherein said means for moving the piston upwardly and downwardly comprises a rocker arm assembly pivotally attached to said tubular body member and reciprocally attached to said piston.

5. The combination defined in Claim 4 and further comprising a thumb lever attached to said rocker arm assembly.

6. A surgical instrument for removing a patch of biological tissue having a predetermined geometrical configuration, said surgical instrument comprising, in combination:

(a) first knife means comprising a hollow, annular knife member with an annular cutting edge having a predetermined geometrical configuration for making an incision from the outer surface of biological tissue into its interior along a closed path;

(b) second knife means for cutting the tissue within said closed path along the exterior of said annular cutting edge; and

(c) guide means for said second knife means connected to, and positioned outside of, said first knife means for guiding said second knife means across the exterior end of said annular cutting edge.

7. A surgical instrument for removing a patch of biological tissue having a predetermined geometrical configuration and a predetermined thickness, said surgical instrument comprising, in combination:

(a) first knife means comprising a hollow, annular knife member with an annular cutting edge having a predetermined geometrical configuration for making an incision from the outer surface of biological tissue into its interior along a closed path;

(b) means for limiting the depth of said incision made by said first knife means;

(c) second knife means for cutting the tissue within said closed path along the exterior of said annular cutting edge; and

(d) guide means for said second knife means connected to, and positioned outside of, said first knife means for guiding said second knife means across the exterior end of said annular cutting edge.

8. The combination defined in Claim 7 wherein said limiting means include stop means connected to said first knife means.

9. The combination of Claim 8 including means for adjusting the position of said stop means relative to said annular cutting edge.

10. The combination defined in Claim 8 wherein said stop means is a plunger mounted within the interior ofsaid annular knife member.

111. The combination of Claim 7 wherein said annular knife member is of circular cross-section,

12. The combination defined in Claim 7 wherein said second knife member is fiat and is of flexible construction, and wherein said mounting means comprises a curved guide member attached to the exterior near one end of said tubular body member, one end of said curved guide member being positioned in alignment with the cutting edge of said annular knife member and means at the other end of said curved guide members for extending said flat knife member from said curved guide member across the exterior of the cutting edge of said annular knife member and for withdrawing said flat knife member back into said curved guide member. 

